Department of Breast Surgery, Breast Health Unit, Mater Misericordiae University Hospital, Dublin, Ireland.
Department of Breast Radiology, Breast Health Unit, Mater Misericordiae University Hospital, Dublin, Ireland.
Breast Dis. 2021;40(3):171-176. doi: 10.3233/BD-201059.
Phyllodes tumours represent 0.3-1% of breast tumours, typically presenting in women aged 35-55 years. They are classified into benign, borderline and malignant grades and exhibit a spectrum of features. There is significant debate surrounding the optimal management of phyllodes tumour, particularly regarding appropriate margins.
This is a retrospective review of a prospectively maintained database of patients who underwent surgical management for phyllodes tumours in a single tertiary referral centre from 2007-2017. Patient demographics, tumour characteristics, surgical treatment and follow-up data were analysed. Tumour margins were classified as positive (0 mm), close (≤2 mm) and clear (>2 mm).
A total of 57 patients underwent surgical excision of a phyllodes tumour. The Mean age was 37.7 years (range: ages 14-91) with mean follow-up of 38.5 months (range: 0.5-133 months). There were 44 (77%) benign, 4 (7%) borderline and 9 (16%) malignant phyllodes cases. 54 patients had breast conserving surgery (BCS) and 3 underwent mastectomy. 30 (53%) patients underwent re-excision of margins. The final margin status was clear in 32 (56%), close in 13 (23%) and positive in 12 (21%). During follow-up, 4 patients were diagnosed with local recurrence (2 malignant, 1 borderline and 1 benign pathology on recurrence samples).
There are no clear guidelines for the surgical management and follow-up of phyllodes tumours. This study suggests that patients with malignant phyllodes and positive margins are more likely to develop local recurrence. There is a need for large prospective studies to guide the development of future guidelines.
叶状肿瘤占乳腺肿瘤的 0.3-1%，多见于 35-55 岁女性。它们分为良性、交界性和恶性，并表现出一系列特征。叶状肿瘤的最佳治疗方法存在很大争议，特别是关于适当的切缘。
这是对 2007 年至 2017 年期间在一家三级转诊中心接受手术治疗的叶状肿瘤患者的前瞻性维护数据库进行的回顾性研究。分析了患者的人口统计学、肿瘤特征、手术治疗和随访数据。肿瘤边缘分为阳性（0mm）、接近（≤2mm）和清晰（>2mm）。
共有 57 例患者接受了叶状肿瘤的手术切除。平均年龄为 37.7 岁（年龄范围：14-91 岁），平均随访时间为 38.5 个月（范围：0.5-133 个月）。良性 44 例（77%），交界性 4 例（7%），恶性 9 例（16%）。54 例患者行保乳手术（BCS），3 例行乳房切除术。30 例（53%）患者行边缘再切除。最终边缘状态为清晰 32 例（56%），接近 13 例（23%），阳性 12 例（21%）。随访期间，4 例患者诊断为局部复发（2 例恶性，1 例交界性，1 例良性病理复发）。
叶状肿瘤的手术治疗和随访尚无明确指南。本研究表明，恶性和阳性边缘的叶状肿瘤患者更有可能发生局部复发。需要进行大型前瞻性研究，以指导未来指南的制定。
